CDC Media Update: XDR TB Public Health Investigation

The Centers for Disease Control and Prevention provides the following update regarding its investigation and public health actions related to a patient with extensively drug-resistant tuberculosis (XDR TB). CDC is recommending that passengers and crew on two trans- Atlantic flights taken by the patient be notified of potential exposure to tuberculosis and evaluated for TB. On May 12, the patient flew from Atlanta, Georgia, to Paris, Francis on Air France flight #385/Delta Airlines flight #8517. On May 24, the patient flew from Prague, Czech Republic, to Montreal, Canada, on Czech Air flight #0104. There were 292 U.S. residents or citizens on the Air France/Delta flight and two on the Czech Air Flight (the patient and his wife).

Update: Notification of Passengers

As of 12 p.m. on June 2, 2007, there were 292 U.S. residents or citizens identified as having traveled on the Air France flight. Earlier reports identified 310 U.S. citizens or residents on the flight, but that number was updated to 292 based on elimination of duplicate names.

As of 3 p.m. on Saturday, June 2, 2007, CDC staff has talked directly with 160 of the 292 U.S. residents or citizens on board the Air France/Delta flight (i.e., 55 percent), and are actively pursuing contact with the other 132. The 160 contacts range from talking directly to passengers, family members, or relatives (in some cases the U.S. passengers are living in or still visiting other countries). All 26 U.S. passengers in five highest priority rows (i.e. the row the passenger was in and the two rows in front and behind) have been contacted. Six of those are currently outside of the United States and family members or relatives were contacted.

The Denver Health Authority Public Health Department has issued an order that requires that the patient be detained at National Jewish Medical and Research Center until further laboratory tests indicate that he is no longer contagious. The patient is currently considered infectious based on three respiratory tract specimens that were reported culture positive for extensively drug-resistant tuberculosis (XDRTB).

Since the order by local public health authorities puts in place measures that are sufficient to protect the public’s health, the federal isolation order that has been used to ensure the patient remains in medical isolation is no longer in place. CDC will continue to provide input and consultation to appropriate authorities on the diagnosis, management and methods for preventing the spread of communicable disease.

Update: CDC activities

CDC will be undertaking a number of reviews related to this XDR TB case. One aspect of this review will be looking at how the CDC employee who is related (father-in-law) to the patient was involved in this matter.

Information for Media Audiences

Many recent media stories have conveyed information or impressions regarding tuberculosis that are inaccurate, including information about how the disease is transmitted, how quickly people may become infected or show symptoms, and the contagiousness of the disease.

There are some other important characteristics of tuberculosis that need to be conveyed:

Only a person with active TB disease can spread TB bacteria to others.

Persons who have spent prolonged time with someone with active TB disease should get tested for TB infection. It usually takes prolonged exposure to someone with active TB disease for someone to become infected.

After exposure, it usually takes 8 to 10 weeks before the TB test would show if someone had become infected.

A person with a positive test for TB infection (i.e., latent TB infection) is not sick, and cannot spread TB germs to others. However, some of these persons can go on to develop TB disease, especially if their immune system is weak, for example, HIVinfected persons, persons with diabetes, or persons undergoing treatment for certain forms of cancer.

Frequently asked question:What should a person do if they were on the Air France flight #385 / Delta flight 8517 on May 12 with the XDR TB patient?

They need to go to their doctor or local health department and request a TB evaluation, as well as contact their State TB Control Office. They should be evaluated for signs and symptoms of TB disease, and get a TB skin test or the QuantiFERON®TB Gold blood test (QFT-G) to test for TB infection.

It can take 8 to 10 weeks after infection for a person’s immune system to react to the TB skin test or QFT-G. It is important to get a TB test as soon as possible because people may already have latent TB infection, but are unaware since there are no signs and symptoms. The first test is needed to determine whether a person already had latent TB infection before this recent exposure. A person with latent TB is not infectious.

If a person’s first test is negative, they will still need to get a second TB test 8 to 10 weeks following the flight date (i.e., the time of their last possible exposure to the patient) to determine if they may have been infected by the XDR TB patient. If the first test is positive, their doctor or nurse may do other tests to see if treatment is needed.

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